Heroin

Heroin was first synthesized in 1874 from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. It was commercially marketed in 1898 as a new pain remedy and became widely used in medicine in the early 1900s until it became a controlled substance in 1914 under the Harrison Narcotic Act. Heroin is a highly addictive drug and is considered the most abused and most rapidly acting opiate.
Heroin comes in various forms, but pure heroin is a white powder with a bitter taste. Most illicit heroin comes in powder form in colors ranging from white to dark brown. The colors are due to the impurities left from the manufacturing process or the presence of additives. “Black tar” (lower left picture) is another form of heroin that resembles roofing tar or is hard like coal. Color varies from dark brown to black.

Effects

Heroin can be injected, smoked, or snorted. Intravenous injection produces the greatest intensity and most rapid onset of euphoria. Effects are felt in 7 to 8 seconds. Even though effects for sniffing or smoking develop more slowly, beginning in 10 to 15 minutes, sniffing or smoking heroin has increased in popularity because of the availability of high-purity heroin and the fear of sharing needles. Also, users tend to mistakenly believe that sniffing or smoking heroin will not lead to addiction.
After ingestion, heroin crosses the blood-brain barrier. While in the brain, heroin converts to morphine and binds rapidly to opioid receptors. Users tend to report feeling a “rush” or a surge of pleasurable sensations. The feeling varies in intensity depending on how much of the drug was ingested and how rapidly the drug enters the brain and binds to the natural opioid receptors. The rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the user’s arms and legs. The user may also experience nausea, vomiting, and severe itching. Following the initial effects, the user will be drowsy for several hours with clouded mental function and slow cardiac function. Breathing is slowed, possibly to the point of death.
Repeated heroin use produces tolerance and physical dependence. Physical dependence causes the user’s body to adapt to the presence of the drug and withdrawal symptoms occur if use is reduced. Withdrawal symptoms begin within a few hours of last use and can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and involuntary leg movements. These symptoms peak between 24 and 48 hours after the last dose and subside after about a week, but may persist for up to a month. Heroin withdrawal is not usually fatal in an otherwise healthy adult, but can cause death to the fetus of a pregnant addict.

Availability

According to What America’s Users Spend on Illegal Drugs, heroin expenditures were an estimated $22 billion in 1990, and decreased to $10 billion in 2000. During 1990, Americans consumed 13.6 metric tons of heroin. Current estimates of heroin consumption remain relatively unchanged and show that 13.3 metric tons of heroin were consumed in 2000.

Production and Trafficking

According to the National Drug Intelligence Center’s National Drug Threat Assessment 2003, heroin is cultivated from opium poppies in four source areas: South America, Mexico, and Southeast and Southwest Asia. Opium cultivation decreased from 5,082 metric tons during 2000 to 1,255 metric tons during 2001. This led to a reduction in heroin production from 482.2 metric tons during 2000 to 109.3 metric tons during 2001.
South American heroin is the most prevalent type of heroin in the United States. Colombian criminal groups, operating independently of major cocaine cartels, dominate the smuggling of South American heroin into the United States. Others involved in the transportation of South American heroin include Bahamian, Dominican, Guatemalan, Haitian, Jamaican, and Puerto Rican criminal groups.
Heroin is smuggled into the United States through the air, sea, land, and mail services. Once in the United States, heroin is distributed at the wholesale level, most frequently by Columbian, Dominican, Mexican, Nigerian, and Chinese criminal groups described as small, independent, and loosely structured. Retail- or street-level distribution of heroin is handled by a larger array of criminal groups. Gangs also are involved in the wholesale and retail distribution of heroin. Many members of national gangs, such as the Gangster Disciples, Vice Lords, and Latin Kings, keep links to heroin traffickers to guarantee a constant supply of the drug.

Price and Purity

During 2001, wholesale prices for South American heroin ranged from $50,000 to $250,000 per kilogram. Southeast and Southwest Asian heroin wholesale prices ranged from $35,000 to $120,000 per kilogram, and Mexican heroin ranged from $15,000 to $65,000 per kilogram. Street-level heroin usually sells for $10 per dose, although prices vary throughout the country.
According to the Drug Enforcement Administration (DEA), during 2000, retail purity levels of heroin ranged from 48.1% for South American heroin, to 34.6% for Southwest Asian heroin, to 20.8% for Mexican heroin. The national average purity for retail heroin from all sources was 36.8%.

Consequences of Use

Chronic heroin use can lead to medical consequences such as scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses and other soft-tissue infections, and liver or kidney disease. Poor health conditions and depressed respiration from heroin use can cause lung complications, including various types of pneumonia and tuberculosis.
Addiction is the most detrimental long-term effect of heroin use because it is a chronic, relapsing disease characterized by compulsive drug seeking and use, as well as neurochemical and molecular changes in the brain.
Long-term effects of heroin use also can include arthritis and other rheumatologic problems and infection of bloodborne pathogens such as HIV/AIDS and hepatitis B and C (which are contracted by sharing and reusing syringes and other injection paraphernalia). It is estimated that injection drug use has been a factor in onethird of all HIV and more than half of all hepatitis C cases in the United States.
Heroin use by a pregnant woman can result in a miscarriage or premature delivery. Heroin exposure in utero can increase a newborns’ risk of SIDS (sudden infant death syndrome).
Street heroin is often cut with substances such as sugar, starch, powdered milk, strychnine and other poisons, and other drugs. These additives may not dissolve when injected in a user’s system and can clog the blood vessels that lead to the lungs, liver, kidneys, or brain, infecting or killing patches of cells in vital organs. In addition, many users do not know their heroin’s actual strength or its true contents and are at an elevated risk of overdose or death.
According to Drug Abuse Warning Network (DAWN) emergency department (ED) data, there were 93,064 reported mentions of heroin in 2001, an increase of 47.4% since 1994 (see table 2). Preliminary ED data for the first half of 2002 revealed that there were 42,571 mentions of heroin. A drug mention refers to a substance that was recorded (mentioned) during a visit to the ED. Heroin represented 15% of 638,484 total ED episodes in 2001. Approximately 56% of heroin ED mentions were for people ages 35 and older. Almost half (43%) of heroin ED mentions were for whites.
According to DAWN’s 2001 mortality data, of the 42 metropolitan areas studied, 19 areas saw a decrease in the number of heroin/morphine mentions, while 9 areas reported an increase in heroin/morphine mentions.

Treatment

According to Treatment Episode Data Set, heroin accounted for 15.2% of all treatment admissions in 2000 (243,523 admissions). Males accounted for 66.9% of heroin treatment admissions. Treatment admissions by race/ethnicity ranged from 47.3% white, to 24.7% Hispanic, to 24.2% black.
Eighty-one percent of heroin treatment admissions reported daily use of the drug. Almost 80% of heroin admissions had been in treatment before the current episode and 25% had been in treatment five or more times. Methadone treatment was planned to be used for 40% of primary heroin admissions.
Methadone has been used to treat opioid addiction for more than 30 years. This synthetic narcotic suppresses opioid withdrawal symptoms for 24 to 36 hours. Although the patient remains physically dependent on the opioid, the craving from heroin use is reduced and the highs and lows are blocked. This permits the patient to be free from the uncontrolled, compulsive, and disruptive behavior associated with heroin addiction.
Other pharmaceutical approaches to heroin treatment include detoxification, naloxone and naltrexone, LAAM (levo-alpha-acetyl-methadol), and buprenorphine.
Detoxification relieves the withdrawal symptoms experienced when substance use is discontinued. Detoxification is not a treatment for addiction, although it can be used to aid in the transition to long-term treatment.
Naloxone and naltrexone are medications that inhibit the effects of opiates such as morphine and heroin. LAAM, a synthetic opiate similar to methadone, is used to treat heroin addiction. This treatment’s long duration of action (up to 72 hours) allows patients to administer their dosage three times a week instead of daily. Buprenorphine, another opiate treatment, causes weaker opiate effects and is not as likely to cause overdose. Buprenorphine creates a lower level of physical dependence and makes it easier for patients to discontinue medication.

Information Provided by the National Institute of Drug Awareness